急性脑梗死患者血清NRG-1、CHIT1、Cx43、MECP2水平变化及其与病情严重程度、预后的关系

doi:10.3969/j.issn.1006-5725.2026.04.021

Abstract

Abstract:

Objective To investigate the alterations in the serum levels of neurogulin-1 （NRG-1）， chitinase 1 （CHIT1）， gap connexin 43 （Cx43）， and methyl-CpG-binding protein 2 （MECP2） in patients with acute cerebral infarction （ACI）， as well as their associations with the severity and prognosis of the disease. Methods A total of 355 patients with ACI admitted to Wuhan First Hospital from September 2023 to November 2024 were selected as the case group. These patients were divided into the severe group （49 cases）， the moderate group （126 cases）， and the mild group （180 cases） according to their condition. All patients underwent ultra-early intravenous thrombolysis upon admission. After treatment， they were observed for 3 months and then divided into the poor-prognosis group （81 cases） and the good-prognosis group （274 cases） based on the prognosis. Additionally， 355 healthy individuals who underwent physical examinations at Wuhan First Hospital during the same period were selected as the control group at a ratio of 1∶1. The basic data and serum levels of NRG-1， CHIT1， Cx43， and MECP2 were compared among groups. Multivariate Logistic regression analysis was employed to analyze the risk factors of poor prognosis in patients with ACI. The receiver operating characteristic curve （ROC） was plotted to obtain the area under the curve （AUC）， and the predictive value of serum NRG-1， CHIT1， Cx43， and MECP2 for poor prognosis in patients with ACI was analyzed. Results When compared with the control group， the serum level of NRG-1 in the case group was significantly lower， whereas the serum levels of CHIT1， Cx43， and MECP2 were significantly higher （P < 0.05）. The serum level of NRG - 1 gradually declined among the mild， moderate， and severe groups， while the serum levels of CHIT1， Cx43， and MECP2 gradually rose among these three groups （P < 0.05）. The proportions of patients with a score of the National Institutes of Health Stroke Scale （NIHSS） ≥ 15 points at admission， large-area infarction， a time interval of 3 ~ 4.5 h from onset to thrombolysis， and the serum levels of CHIT1， Cx43， and MECP2 in the poor-prognosis group were higher than those in the good-prognosis group （P < 0.05）， and the serum level of NRG-1 was lower than that in the good-prognosis group （P < 0.05）. Multivariate Logistic regression analysis indicated that the serum levels of CHIT1， Cx43， and MECP2 were risk factors for poor prognosis in patients with ACI （P < 0.05）， while the serum level of NRG-1 was a protective factor （P < 0.05）. ROC analysis demonstrated that the AUC value of the combined detection of serum NRG-1， CHIT1， Cx43， and MECP2 in predicting poor prognosis of patients with ACI was 0.931， which was higher than that of the single detection of each index （0.796， 0.801， 0.791， 0.805， P < 0.05）. Conclusions The serum level of NRG-1 in patients with acute cerebral infarction （ACI） was low， whereas the serum levels of CHIT1， Cx43， and MECP2 were high. These four factors were associated with the patients' disease severity and poor prognosis. Simultaneously， the combined detection of serum NRG-1， CHIT1， Cx43， and MECP2 exhibited a higher predictive value for the poor prognosis of ACI patients.

Key words: acute cerebral infarction, neurogulin-1, chitinase-1, gap connexin 43, methylated CpG-binding protein 2, severity, prognosis

CLC Number:

R743.33

Jinsong LI,Senxin HUA,Ludan HUANG,Qing SU. Changes in serum levels of NRG-1， CHIT1， Cx43， and MECP2 in patients with acute cerebral infarction and their relationship with severity and prognosis[J]. The Journal of Practical Medicine, 2026, 42(4): 691-697.

Figures/Tables 6

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Fig.1

References 26

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指标	病例组（n = 355）	对照组（n = 355）	t/χ² 值	P值
BMI/（kg/m²）	23.14 ± 1.35	23.08 ± 1.41	0.579	0.563
年龄/岁	63.49 ± 4.22	62.88 ± 5.14	1.728	0.084
性别/［例（%）］			0.051	0.882
男	182（51.27）	179（50.42）
女	173（48.73）	176（49.58）
饮酒史/［例（%）］	113（31.83）	97（27.32）	1.731	0.188
吸烟史/［例（%）］	125（35.21）	108（30.42）	1.846	0.174
NRG-1/（pg/mL）	227.86 ± 37.53	291.33 ± 44.29	20.600	< 0.001
CHIT1/（μg/L）	57.89 ± 6.89	24.63 ± 3.44	81.374	< 0.001
Cx43/（pg/mL）	93.41 ± 16.54	46.88 ± 10.22	45.091	< 0.001
MECP2/（pg/mL）	561.27 ± 88.65	406.72 ± 74.31	25.173	< 0.001

指标	轻度组（n = 180）	中度组（n = 126）	重度组（n = 49）	F值	P值
NRG-1/（pg/mL）	243.38 ± 32.49	224.56 ± 25.79^*	179.34 ± 22.57^*#	95.010	< 0.001
CHIT1/（μg/L）	53.92 ± 4.13	57.21 ± 5.58^*	74.22 ± 8.83^*#	262.854	< 0.001
Cx43/（pg/mL）	85.50 ± 13.41	95.22 ± 14.21^*	117.83 ± 22.47^*#	88.136	< 0.001
MECP2/（pg/mL）	526.14 ± 57.22	552.67 ± 92.31^*	712.45 ± 109.43^*#	106.847	< 0.001

指标	预后不良组（n = 81）	预后良好组（n = 274）	t/χ² 值	P值
BMI（x ± s）/（kg/m²）	23.27 ± 1.42	23.10 ± 1.45	0.931	0.352
年龄（x ± s）/岁	64.11 ± 3.97	63.31 ± 4.16	1.536	0.125
性别			0.392	0.531
男	44（54.32）	138（50.36）
女	37（45.68）	136（49.64）
入院时NIHSS评分			8.221	0.004
< 15分	62（76.54）	244（89.05）
≥ 15分	19（23.46）	30（10.95）
梗死位置			0.849	0.457
后循环	32（39.51）	93（33.94）
前循环	49（60.49）	181（66.06）
梗死面积			12.325	<0.001
大面积梗死	40（49.38）	78（28.47）
小面积及腔隙性梗死	41（50.62）	196（71.53）
发病至溶栓时间			13.920	< 0.001
< 3 h	53（65.43）	231（84.31）
3 ~ 4.5 h	28（34.57）	43（15.69）
溶栓后出血	12（14.81）	23（8.39）	2.900	0.089
合并糖尿病	19（23.46）	56（20.44）	0.342	0.559
合并高脂血症	35（43.21）	101（36.86）	1.066	0.302
合并高血压	32（39.51）	98（35.77）	0.377	0.539
饮酒史	29（35.80）	84（30.66）	0.763	0.382
吸烟史	32（39.51）	93（33.94）	0.849	0.357
NRG-1（x ± s）/（pg/mL）	181.34 ± 40.57	241.61 ± 67.88	7.595	< 0.001
CHIT1（x ± s）/（μg/L）	69.43 ± 13.15	54.48 ± 10.93	10.305	< 0.001
Cx43（x ± s）/（pg/mL）	115.89 ± 31.25	86.76 ± 19.54	10.134	< 0.001
MECP2（x ± s）/（pg/mL）	689.23 ± 133.55	523.44 ± 101.22	11.984	< 0.001

因素	β	SE	Wald χ²	P值	OR	95%CI
入院时NIHSS评分≥ 15分	0.672	0.379	3.144	0.076	1.958	0.932 ~ 4.116
大面积梗死	0.544	0.297	3.355	0.067	1.723	0.963 ~ 3.084
发病至溶栓时间为3 ~ 4.5 h	0.712	0.381	3.492	0.062	2.038	0.966 ~ 4.301
NRG-1	-0.594	0.188	9.983	0.002	0.552	0.382 ~ 0.798
CHIT1	0.813	0.269	9.134	0.003	2.255	1.331 ~ 3.820
Cx43	0.614	0.226	7.381	0.007	1.848	1.187 ~ 2.878
MECP2	0.688	0.214	10.336	0.001	1.990	1.308 ~ 3.027

指标	截断值	AUC	95%CI	P值	敏感度/%	特异度/%
NRG-1	218.51 pg/mL	0.796^*	0.750 ~ 0.836	< 0.001	67.88	82.72
CHIT1	59.17 μg/L	0.801^*	0.756 ~ 0.841	< 0.001	75.31	70.80
Cx43	102.45 pg/mL	0.791^*	0.745 ~ 0.832	< 0.001	67.90	82.85
MECP2	643.53 pg/mL	0.805^*	0.760 ~ 0.845	< 0.001	62.92	91.24
联合检测		0.931	0.899 ~ 0.955	< 0.001	85.19	87.96

Changes in serum levels of NRG-1， CHIT1， Cx43， and MECP2 in patients with acute cerebral infarction and their relationship with severity and prognosis

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